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An outbreak of cat-associated Q fever in the United States.

Q fever is usually acquired by contact with aerosols generated during parturition of domestic ungulates (e.g., sheep, cows, goats). In the maritime provinces of Canada, parturient cats have also been implicated in its transmission. A 66-year-old woman from eastern Maine developed high fever, rigors, headache, myalgias, pulmonary infiltrates, and elevated hepatocellular enzymes, and the diagnosis of acute Q fever was confirmed serologically. She and 14 other family members had attended a family reunion in Maine 2 weeks earlier, when they were exposed to a parturient cat. All 11 adults and older children attending the reunion developed symptoms consistent with acute Q fever. Serum samples were obtained from 10 who attended the reunion and 8 who did not attend. Titers greater than or equal to 1:64 to Coxiella burnetii were present in all who attended the reunion but in none of those who did not. Cat-associated Q fever should be considered when sporadic cases of the disease occur in the United States.

Adolescent↗

Interaction of rickettsiae with haemocytes of Alveonasus lahorensis ticks.

The development of different rickettsial species (Rickettsia sibirica, R. conorii, R. acari and coxiella burnetii) in haemocytes of Alveonasus lahorensis ticks was compared by viral observations and time-lapse cine-micrography. The interaction of different rickettsial species with the haemocytes in vitro had specific characteristic features and reflected the pattern of interaction of the rickettsiae with tick cells in vivo.

Animals↗

The two faces of autophagy: Coxiella and Mycobacterium.

In the world of pathogen-host cell interactions, the autophagic pathway has been recently described as a component of the innate immune response against intracellular microorganisms. Indeed, some bacterial survival mechanisms are hampered when this process is activated. Mycobacterium tuberculosis infection of macrophages, for example, is impaired upon autophagy induction and the bacterial phagosomes are redirected to autophagosomes. On the other hand, pathogens like Coxiella burnetii are benefited by this cellular response and subvert the autophagy process resulting in a more efficient replication. We study at the molecular level these two different faces of the autophagy process in pathogen life in order to elucidate the intricate routes modulated by the microorganisms as survival strategies.

Animals↗

Identification of phase-specific antigenic fractions of Coxiella burnetti by enzyme-linked immunosorbent assay.

Antigenic fractions of Coxiella burnetii phase variants were identified with an enzyme-linked immunosorbent assay (ELISA). Immune sera from guinea pigs immunized with Formalin-inactivated phase I or phase II whole cells were used to measure the antigenic activity of whole cells and various soluble and particulate preparations. Phase-specific antigens of C. burnetii whole cells and fractions were compared by dose-response curves at different (antigen and antibody) dilutions. Water-soluble extracts prepared by meta-periodate, ether, and phenol extraction of phase I whole cells yielded antigenic fractions which reacted with anti-phase I antibodies. The extraction of phase I whole cells with dimethyl sulfoxide, trichloracetic acid, and Formalin yielded antigenic fractions which detected antibodies in both anti-phase I and -phase II sera. Interestingly, the trichloracetic acid extract of phase I whole cells also contained a component which bound nonimmune immunoglobulin. The sera of animals immunized with whole cells of the phase II Australian QD strain reacted with lipopolysaccharides of the phase I and phase II Nine Mile strains. Therefore, variations in lipopolysaccharide structure among phase variants of C. burnetii were detected as cross-reactions with immune sera from an interspecific strain. Comparisons of immunofluorescence, microagglutination, and the complement fixation assays with the ELISA indicated greater sensitivity and specificity of the ELISA for the measurement of phase-specific antigens and antibodies.

Animals↗

An outbreak of Q fever affecting postal workers in Oxfordshire.

Twenty-five people in Oxfordshire were found to have had clinical illness due to Q fever in the 3 months from April to June 1983. Twelve cases were diagnosed through the routine laboratory diagnostic service. Five of these were postmen, four of whom worked in a sorting office where an outbreak of illness similar to influenza had been noted by the Occupational Health Nurse. Thirteen cases were diagnosed by active case-finding in this sorting office but investigation failed to define the source of the outbreak. Nine of the 18 postal workers were found to have antibodies to phase I Coxiella burnetii antigen. The significance of these antibodies is discussed. Surveillance for over 2 years has not revealed anyone with symptoms or signs suggestive of chronic Q fever. An outbreak of Q fever among postal workers has not previously been described. We recommend continued surveillance for this enigmatic condition.

Antibodies, Bacterial↗

[Q-fever as a cause of myocarditis in childhood].

Q-fever occurs in The Netherlands in childhood more often than used to be believed. We treated an 8-month-old infant with congestive myocarditis associated with a seroconversion against Coxiella burnetii. The infection was probably caused by the father, who a few weeks earlier had visited his native Surinam, where he frequently was surrounded by domestic animals and drank raw cow's milk. After 2.5 years the child's general and cardial conditions are good although digoxin therapy is still necessary.

Antibodies, Bacterial↗

Tick-borne rickettsioses in Pune district, Maharashtra, India.

An extensive study on tick-borne rickettsioses in the Pune district of Maharashtra revealed that Indian tick typhus exists as a zoonosis, which only occasionally causes disease in man. By sero-conversion in guinea pigs, presumptive isolates of Rickettsia conori and Coxiella burnetii were recovered from 4 of the 11 species of ticks examined. Boophilus microplus and Rhipicephalus haemaphysalis were found to be harbouring R. conori whereas C. burnetii was isolated from Haemaphysalis intermedia and Hyalomma hussaini in addition to the above mentioned 2 tick species. Complement fixation tests carried out on sera from various species of rodents and gerbils revealed the presence of antibodies against the R. conori antigen in the sera of Rattus blanfordi, R.r. rufescens and Suncus murinus. In the case of large mammals, similar antibodies were detected in the sera from dog, cow, horse and sheep. C. burnetii infection was found to exist in both the sylvan and domestic cycle, as evidenced from the involvement of ticks, large and small mammals and man in its natural history.

Adolescent↗

A novel ubiquitous protein 'chaperonin' supports the endosymbiotic origin of mitochondrion and plant chloroplast.

The deduced amino acid sequences for a major mitochondrial protein (designated P1, related to the 'chaperonin' family of proteins) from human and Chinese hamster cells show extensive similarity (greater than 60% identity observed over the entire length) with a related protein present in evolutionarily as divergent organisms as Escherichia coli, Coxiella burnetii, Mycobacterium species, cyanobacteria as well as in yeast mitochondria and higher plant chloroplasts. Of the different groups of bacteria for which sequence data is available, maximum similarity of the mammalian/yeast P1 protein is observed with the corresponding protein from purple bacteria (especially C. burnetii) while the protein from plant chloroplasts exhibited highest similarity with the corresponding protein from cyanobacteria. The sequence data for this protein thus support the contention that the endosymbiont that gave rise to mitochondrion was a member of purple bacteria, while plant chloroplast originated from a member of the cyanobacterial lineage.

Amino Acid Sequence↗

Q fever endocarditis in the United States.

A patient with Q fever endocarditis, which is almost unknown in the United States, was followed for a total of 32 months; the study was begun 3 1/2 months before aortic valve replacement. Diagnosis was confirmed by serology, visualization of Coxiella burnetii in excised aortic valve tissue by direct and immunofluorescence staining, and isolation of C. burnetii from aortic valve tissue. Serum antibodies against phase I and phase II antigens of C. burnetii were identified. Almost all phase I and phase II antibodies were IgG. These findings are compared with those in an uncomplicated case of acute Q fever. New findings on the immune response to chronic Q fever are presented.

Animals↗

Immunoglobulin responses in acute Q fever.

Knowledge of the development of different classes of antibody during the course of acute Q fever is important to the clinician for interpreting a patient's serological test results. In the present study, the appearance of antibodies to Coxiella burnetii phases I and II was determined for a period of 1 year. A total of 683 sera from 191 patients with symptomatic Q fever were evaluated by the complement fixation and indirect immunofluorescence (immunoglobulins M and G [IgM, IgG]) tests. These patients had contracted acute Q fever in the fall of 1983 during an epidemic that resulted in 415 serologically confirmed cases of Q fever. As demonstrated by the complement fixation test, antibodies to C. burnetii phase II remained elevated throughout the entire study period, whereas antibodies to phase I were barely detectable. Although the immunofluorescence test was more sensitive than the complement fixation test, the specific anti-IgG response to C. burnetii to phases I and II gave the same general antibody profiles as did the complement fixation test. IgM anti-phase I and II titers appeared earlier but disappeared after 10 to 12 weeks. During this period, anti-phase II antibody levels were generally much higher than anti-phase I antibody levels.

Antibodies, Bacterial↗

Endocarditis due to Q fever in Nova Scotia: experience with five patients in 1981-1982.

Q fever endocarditis is rarely reported in North America; only four cases have been documented since 1953. In 1981-1982, five cases were identified in the Victoria General Hospital, Halifax, Nova Scotia. Four patients were from widely separated areas of Nova Scotia and one was from Prince Edward Island. Four patients with long-standing valvular abnormalities, including two with prosthetic valves, presented with recurrent febrile episodes. The fifth patient, who was previously well, had recurrent septic embolic episodes. Clinical features and laboratory findings were variable. Diagnosis by serology was confirmed in four patients by culture of Coxiella burnetii from excised tissue. Histopathology varied from nonspecific inflammatory changes to two more distinctive patterns; electron microscopy showed C burnetii in two patients. Therapy with tetracycline and trimethoprim-sulfamethoxazole was beneficial, although three patients required valve replacement for hemodynamic deterioration. Q fever endocarditis may be more common than is recognized, and serological investigations should be performed in all cases of culture-negative endocarditis.

Adult↗

Immunity in Q fever.

Post-infection and post-vaccination immune mechanisms in Q fever are summarized. Whereas cell-mediated immunity has been found to play a crucial role in developing resistance to Coxiella burnetii infection, data on the role of specific antibodies in Q fever immunity are controversial. The functional state of immunocompetent cells and professional phagocytes seems to be decisive for the persistence of C. burnetii within phagocytic cells and for the control of Q fever at the host level. Defects of cellular immunity, immune complex formation, and immune response modulation by C. burnetii isolates differing in plasmid composition or LPS antigenic structure are implicated as aetiological factors. Immunogenicity and reactogenicity of three possible vaccine candidates (phase I chloroform-methanol treated and untreated corpuscular vaccine, and phase I soluble chemovaccine) for Q fever prophylaxis is discussed, stressing the need for developing suitable models and defined experimental conditions enabling to compare and evaluate the results obtained in different laboratories.

Animals↗

Rhipicephalus ticks infected with Rickettsia and Coxiella in Southern Switzerland (Canton Ticino).

Ticks of the Rhipicephalus sanguineus species complex may be vector of various pathogens including Rickettsia conorii (the etiological agent of the Mediterranean spotted fever) and Coxiella burnetii (cause of the Query (Q) fever). R. sanguineus ticks have been imported in several parts of central and northern Europe, especially in environments such as kennels and houses providing the appropriate microclimatic conditions and the blood source necessary for their survival. Since 1940 these ticks have occasionally been recorded in Switzerland. In Ticino (the southern part of Switzerland), they have been reported since 1980 and their probable establishment in this area has been suggested in the '90s. By means of PCR and direct sequencing, we tested the identity of these ticks (using 12S rDNA gene) and the occurrence of Rickettsia spp. (using 16S rDNA, gltA and OmpA genes) as well as Coxiella sp. (using 16S rDNA). The results indicated that in Ticino, two different tick species coexist, i.e. R. sanguineus sensu stricto and Rhipicephalus turanicus. A few individuals of R. sanguineus sensu stricto are infected with Rickettsia massiliae/Bar29, which are strains of unknown pathogenicity. Coxiella sp., an endosymbiont of Rhipicephalus ticks, has also been identified in both tick species. Due to climatic changes towards global warming, imported tick species may therefore adapt to new area and might be considered as epidemiological markers for a number of infectious agents transmitted by them.

Animals↗

Vaccine prophylaxis of abattoir-associated Q fever: eight years' experience in Australian abattoirs.

During the period 1981-8 a clinical trial of a Q fever vaccine (Q-vax; Commonwealth Serum Laboratories, Melbourne) has been conducted in abattoir workers and other at-risk groups in South Australia. Volunteers in four abattoirs and visitors to the abattoirs were given one subcutaneous dose of 30 micrograms of a formalin-inactivated, highly-purified Coxiella burnetii cells, Henzerling strain, Phase 1 antigenic state, in a volume of 0.5 ml. During the period, over 4000 subjects have been vaccinated and the programme continues in the abattoirs and related groups. 'Common' reactions to the vaccine comprised tenderness and erythema, rarely oedema at the inoculation site and sometimes transient headache. Two more serious 'uncommon' reactions, immune abscess at the inoculation site, were observed in two subjects, and two others developed small subcutaneous lumps which gradually dispersed without intervention. Protective efficacy of the vaccine appeared to be absolute and to last for 5 years at least. Eight Q fever cases were observed in vaccinees, but all were in persons vaccinated during the incubation period of a natural attack of Q fever before vaccine-induced immunity had had time (greater than or equal to 13 days after vaccination) to develop. On the other hand, 97 Q fever cases were detected in persons working in, or visiting the same abattoir environments. Assays for antibody and cellular immunity showed an 80-82% seroconversion after vaccination, mostly IgM antibody to Phase 2 antigen, in the 3 months after vaccination. This fell to about 60%, mostly IgG antibody to Phase 1 antigen, after 20 months. On the other hand, 85-95% of vaccinees developed markers of cell mediated immunity as judged by lymphoproliferative responses with C. burnetii antigens; these rates remained elevated for at least 5 years. The Q fever vaccine, unlike other killed rickettsial vaccines, has the property of stimulating long-lasting T lymphocyte memory and this may account for its unusual protective efficacy as a killed vaccine.

Abattoirs↗

Experimental Q fever infection in congenitally athymic nude mice.

Congenitally athymic nude (nu/nu) mice and their phenotypically normal (nu/+) euthymic littermates were exposed to Coxiella burnetii administered as small-particle aerosols. After challenge, both strains of mice became infected, as characterized by rickettsemia, viable rickettsiae in the spleen, and serological conversion. The major difference noted was that euthymic animals had cleared rickettsiae from peripheral circulation and the spleen within 14 days. In contrast, rickettsiae were detected and isolated from spleen and blood of athymic mice through 60 days.

Animals↗

Q fever in the Netherlands: a sero-epidemiological survey among human population groups from 1968 to 1983.

A sero-epidemiological survey, using an indirect immunofluorescence test for IgG against Coxiella burnetii (phase II), was carried out in the Netherlands. Serum samples taken in 1968, 1975, 1979 and 1983 were tested. Occupational groups with a supposedly high risk of infection (veterinarians, residents of dairy farms and taxidermists) showed a significantly higher percentage of seropositives than defined controls. The percentage of seropositive amateur wool spinners was significantly higher than that of the controls from the same region. Since 1968 there has been no increase in the percentage of infected persons, indicating that, contrary to earlier assumptions, Q fever has been endemic in The Netherlands for a long time already. The increase in numbers of notified cases of overt Q fever is considered to be the result of the recent introduction of a sensitive indirect immunofluorescence test for IgM antibodies against C. burnetii. Antibody percentages in all age classes between 1 and 64 years were much alike, suggesting that most infections occur in early childhood. This is in accordance with the finding that 35% of our patients are younger than 3 years. The possibility of infection related to childbirth and lactation is discussed.

Adolescent↗

Chlamydial hemagglutinin identified as lipopolysaccharide.

Chlamydial lipopolysaccharide (LPS) agglutinated mouse and rabbit erythrocytes but not human, guinea pig, or pronghorn antelope erythrocytes. Hemagglutination was not specific for Chlamydia spp., as rough LPSs from Coxiella burnetii and Escherichia coli also agglutinated erythrocytes from the same animal species. Nonagglutinated and agglutinated erythrocytes bound equivalent amounts of LPS, indicating that hemagglutination was not due to a specific interaction of chlamydial LPS with erythrocytes. Thus, hemagglutination by chlamydial LPS is not mediated by specific receptor-ligand interactions but is a property of the altered surface of the LPS-coated erythrocytes.

Animals↗

The value of skin test in Q fever convalescents and vaccinees as indicator of antigen exposure and inducer of antibody recall.

The skin test (ST) with Q fever chemovaccine revealed more positive reactors than the serological examination by microagglutination (MA) test among humans, who had suffered from Q fever one to eleven years ago or who had been vaccinated with Q fever chemovaccine from three months to four years ago. When examining the sera harvested either at skin-testing or two weeks thereafter by MA test, seroconversion or rise in antibody titres were found to both main Coxiella burnetii (C. b.) antigens. The rise or appearance of antibody response was similar in Q fever convalescents and vaccinees, in the latter occurring more often in ST positive than in ST negative individuals. Results of ST at different postvaccination (p.v.) intervals corresponded well to those of lymphocyte transformation (LT) test, but not to those of inhibition of leukocyte migration ( ILM ) test.

Agglutination Tests↗